diabetic foot ulcer seminar

8/15/2019 Diabetic Foot Ulcer Seminar

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Mardhati Ab Rahman

012011100026

DIABETIC FOOT ULCER


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• Any infection involving the foot in aperson with diabetes originating in achronic or acute injury to the soft

tissues of the foot, with evidence ofpree!isting neuropathy and"orischemia#

$nternational %onsensus on&iagnosing and 'reating the $nfected&iabetic (oot )200*+

WHAT IS DIABETIC FOOT ULCER?


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ccur in 1-. of diabetic patient

/0. of nontrauma relatedamputations are forcomplications of diabetes

EPIDEMIOLOGY


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1# redisposition to peripheral

vascular disease2# eripheral neuropathy

*# Reduced resistance toinfection

/# steoporosis

RISK FACTORS


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Peripheral "e!r#pa$h%

Motor

&amage to the innervations of theintrinsic foot muscles imbalance between e!ion ande!tension of the aected foot anatomic foot deformities that

create abnormal bony prominencesand pressure points)claw toes with high arch+ s3in

brea3down and plantar ulceration

gy


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"e!r#pa$h%

Autonomic

Autonomic neuropathy diminutionin sweat and oil gland functionality the foot loses its natural ability to

moisturi4e the overlying s3in andbecomes dry and increasingly

susceptible to tears and thesubse5uent development of infection

gy


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"e!r#pa$h%

ensory

(irst sensation lost is vibration andproprioception

atients are often complain ofparaesthesia or symmetricalnumbness and unable to detect theinsult to their lower e!tremities many wounds go unnoticed andprogressively worsen as the aected

area is continuously subjected to

gy


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I&'e$i#&

7ncontrolled diabetes reducesimmunity and in combination withperipheral neuropathy and ischemia,increases the ris3 of infection after

minor trauma

PATHOPHYOLOGY


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Os$e#p#r#sis

8oss of bone density in diabetesmay be severe enough to result ininsuiciency fractures around the

an3le or in the metatarsals

PATHOPHYSIOLOGY


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CLASSIFICATIO N AN D SYM PTO M S O F

D IABETIC FO O T U LCER , CH ARCO T

FOOT

AMALINA BT AZMAN012012100140


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•Hypaesthesia

•Hyperesthesia

•Paresthesia

•Dysesthesia

•Radicular pain•Anhydrosis

•Usually asymptomatic

•Intermittent claudication

•Ischemic pain at rest

•Non-healing ulceration of

the foot

Per iphera l

Neuropath

Per iphera l

Insu f f ic ienc

SYMPTOMS OFDIABETIC FOOT

ULCER


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ccur in less than 1. of diabetic patient A relatively painless, progressive and degenerative

arthropathy of single or multiple joints caused byan underlying neurological de9cit#

$t is a neuropathic joint disease causing wea3eningof the bones)bone destruction, resorption and

deformity+ in the foot that can occur in people whohave signi9cant neuropathy#

'he bones are wea3ened enough to fracture, andwith continued wal3ing the foot eventuallychanges shape#

Most commonly aect midtarsal joints, metatarsalphalangeal joint and an3le joints

CHARCOT FOOT


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$t varies depending on the stage ofthe disease from mild swelling to

severe swelling and moderate

deformity#$ntact s3in, $nammation, erythema,pain and increased s3in temperature

)*:; degrees %elsius+ around the jointmay be noticeable on e!amination#


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INVESTIGATIO

N &

TREATMENTDINIE HAZIRAH BINTIHASAN012012100161


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INVESTIGATIONS

• Full blood count

• HbA1c

•

Renal Profle• Fasting blood sugar

• Doppler studies and ultrasound

•

Imaging


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• The an!"e#$rac%a" 'ressure n(e) (AB*I) or an!"e#$rac%a" n(e) (ABI) is

the ratio o the sstolic blood pressure inan!le to brachium

• "o#er leg $P is indicati%e o arterialbloc!age due to peripheral arter disease

• The patient must be placed supine&#ithout the head or an e'tremitiesdangling o%er the edge o the table

A"*+$RA,HIA" PR*--.R* ID*/(A$PI)


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0ethod A$I


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Interpretation A$I


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Radiographs


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TREATMENT

eneral actors important in decidingtreatment plan include 2angiopathic %s3 neuropathic

deep %s3 superfcial

45+ osteomelitis& antibiotics based onbone biops culture sensiti%ities


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on+operati%e

absorbpro%ide moist en%ironmentact as a barrier

First line o treatmento6+load pressure at ulcer

oals o #ound care and dressings is to 2+

act as a barriero6+load pressure at ulcerpro%ide moist en%ironment

First line o treatmentoals o #ound care and dressings is to 2+

absorb


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marginal arterial suppl to a6ected areaHas ade7uate blood suppl and abilit to monitor patient at inter%al o

old -tandard or mechanical relie plantar ulcerationspatients unable to compl #ith cast careAbsolute inectionpatients unable to tolerate a cast (cast claustrophobia)

Total ,ontact ,asting (T,,),ontraindications

Has ade7uate blood suppl and abilit to monitor patient at inter%al opatients unable to compl #ith cast care

,ontraindications Total ,ontact ,asting (T,,)

Absolute inectionmarginal arterial suppl to a6ected areapatients unable to tolerate a cast (cast claustrophobia)

old -tandard or mechanical relie plantar ulcerations


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•S%e +(,catn• pre%ention #hen signs o potential ulcers are

present includes deep or #ide shoes& custominsoles& roc!er bottom soles (the best to reduce

plantar pressure on the oreoot)

•L-e st."e +(,catn•

G"ucse t $e !e't un(er cntr"•B"( 'ressure cntr"•L'( +ana/e+ent•S+!n/ cessatn


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Foot care guide


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9perati%e

Sur/ca" (e$r(e+ent ant$tcs "ca" un( care cntact cas


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THAN3 O5

diabetic foot ulcer seminar

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